The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer

Jonathan M. Hernandez, Whalen Clark, Jill Weber, William J. Fulp, Lauren Lange, David Shibata

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2 Citations (Scopus)

Abstract

Purpose: For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes. Methods: 174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN0·pN0, uN0·pN +, uN+·pN0, and uN+· pN+). Univariate and multivariate analyses were performed. Results: 104 men and 70 women of median age 60 years (29-85 years) were followed for a median of 31 months (1-121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0-39) evaluated. Disease recurred in 3 of 41 (7 %) uN0·pN0, 10 of 52 (20 %) uN+·pN0, 7 of 18 (41 %) uN0· pN+, and 6 of 17 (35 %) uN+·pN+ patients. Those patients having nodal downstaging (uN+·pN 0) experienced superior overall survival (p=0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0. Conclusions: Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)1061-1068
Number of pages8
JournalInternational Journal of Colorectal Disease
Volume29
Issue number9
DOIs
StatePublished - Jan 1 2014

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Rectal Neoplasms
Survival
Adjuvant Chemotherapy
Disease-Free Survival
Multivariate Analysis
Lymph Nodes
Therapeutics

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Medicine(all)

Cite this

The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer. / Hernandez, Jonathan M.; Clark, Whalen; Weber, Jill; Fulp, William J.; Lange, Lauren; Shibata, David.

In: International Journal of Colorectal Disease, Vol. 29, No. 9, 01.01.2014, p. 1061-1068.

Research output: Contribution to journalArticle

Hernandez, Jonathan M. ; Clark, Whalen ; Weber, Jill ; Fulp, William J. ; Lange, Lauren ; Shibata, David. / The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer. In: International Journal of Colorectal Disease. 2014 ; Vol. 29, No. 9. pp. 1061-1068.
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abstract = "Purpose: For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes. Methods: 174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN0·pN0, uN0·pN +, uN+·pN0, and uN+· pN+). Univariate and multivariate analyses were performed. Results: 104 men and 70 women of median age 60 years (29-85 years) were followed for a median of 31 months (1-121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0-39) evaluated. Disease recurred in 3 of 41 (7 {\%}) uN0·pN0, 10 of 52 (20 {\%}) uN+·pN0, 7 of 18 (41 {\%}) uN0· pN+, and 6 of 17 (35 {\%}) uN+·pN+ patients. Those patients having nodal downstaging (uN+·pN 0) experienced superior overall survival (p=0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0. Conclusions: Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.",
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N2 - Purpose: For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes. Methods: 174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN0·pN0, uN0·pN +, uN+·pN0, and uN+· pN+). Univariate and multivariate analyses were performed. Results: 104 men and 70 women of median age 60 years (29-85 years) were followed for a median of 31 months (1-121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0-39) evaluated. Disease recurred in 3 of 41 (7 %) uN0·pN0, 10 of 52 (20 %) uN+·pN0, 7 of 18 (41 %) uN0· pN+, and 6 of 17 (35 %) uN+·pN+ patients. Those patients having nodal downstaging (uN+·pN 0) experienced superior overall survival (p=0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0. Conclusions: Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.

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